Posted on Wednesday, December 17th, 2025 at 11:14 pm
Chronic pain from conditions like fibromyalgia, complex regional pain syndrome (CRPS), and post-surgical pain can make working impossible. Can you receive long-term disability benefits for chronic pain conditions? The answer is yes, but proving your claim requires more than just reporting pain. Insurance companies focus on functional limitations, not diagnoses. This means you’ll need to demonstrate how your pain prevents you from performing work duties.
At Capitan Law, we help clients across the country pursue long-term disability benefits for chronic pain conditions. Our attorneys understand the unique challenges of proving these claims and have successfully appealed denied benefits for fibromyalgia, CRPS, and post-surgical pain.
Understanding Chronic Pain and Work Limitations
Chronic pain is pain that lasts longer than three months and continues even after the original injury heals. Unlike acute pain from a fresh injury, chronic pain persists and can affect every part of your life, including your ability to work.
Three conditions commonly qualify for long-term disability benefits:
- Fibromyalgia causes widespread pain throughout your body, along with fatigue and cognitive problems. People with fibromyalgia struggle to concentrate, remember information, and stay focused during work. The combination of pain and “brain fog” makes many jobs difficult. This condition often requires ongoing medical treatment to manage symptoms.
- Complex Regional Pain Syndrome (CRPS) develops after an injury or surgery. It causes severe, burning pain in the affected limb, along with swelling and limited movement. CRPS can make it hard to grip objects, lift items, or walk, depending on which limb is affected. Understanding CRPS functional limitations is critical for disability claims.
- Post-surgical pain occurs when pain continues long after surgery should have healed. Instead of improving, the pain stays the same or gets worse. This type of pain can prevent you from returning to work even when the surgery itself was successful. Post-surgical pain disability claims require detailed documentation of functional limitations.
Why Insurance Companies Challenge Chronic Pain Claims
Insurance companies deny many chronic pain claims because pain is subjective. Unlike a broken bone that shows up on X-rays, chronic pain has no definitive test. You cannot prove pain with a blood test or imaging scan. This makes it easier for insurers to question whether your pain is real or severe enough to prevent work.
Insurance companies also use surveillance to investigate claims. They may watch you to see if your activities match your reported limitations. If they see you doing something that contradicts your disability claim, even on a “good day,” they may deny your benefits. This surveillance creates credibility issues that make chronic pain claims harder to win.
Many people with chronic pain experience good days and bad days. On good days, you might accomplish tasks that seem impossible on bad days. Insurance companies often focus on your good days and ignore the bad ones. They argue that if you can do something once, you can do it consistently. This misses the reality of chronic pain: unpredictability and inconsistency are part of the condition. Understanding how to prove disability with inconsistent symptoms is essential.
How to Prove Your Chronic Pain Disability Claim
Winning a chronic pain disability claim requires strong evidence of functional limitations. Focus on what you cannot do, not on your diagnosis. Functional capacity evaluations can provide objective evidence of your limitations.
Document Your Functional Limitations
Write down specific tasks you cannot perform or can only perform for short periods. Instead of saying “I have fibromyalgia,” say “I cannot sit at a desk for more than 30 minutes without severe pain” or “I cannot grip objects with my right hand due to CRPS swelling.” Be specific about how long you can perform activities before pain forces you to stop.
Describe how your pain affects work duties. Can you attend meetings? Can you use a computer or lift files or equipment? And, can you stand for customer interactions? The more specific you are about functional limitations, the stronger your claim becomes. The best ways to document your disability include maintaining detailed records and working with your medical team. The role of medical evidence in disability claims cannot be overstated.
Maintain Consistent Medical Treatment
Regular doctor visits demonstrate that you are actively managing your condition. Insurance companies expect to see ongoing treatment. Gaps in treatment give insurers a reason to deny your claim; they may argue you are not disabled if you are not seeking care.
What paperwork you need from your doctor is critical for approval. Keep records of all medical appointments, treatments, and medications. Specialist reports from rheumatologists, pain management doctors, or neurologists often carry more weight than general practitioner notes. These specialists understand chronic pain syndrome and can explain how your condition limits work ability.
Keep Detailed Pain and Activity Journals
Document your pain levels daily. Note what triggered pain spikes and how pain affected your ability to work. Record medication side effects that impact concentration or energy. Over time, these journals show patterns that support your claim. Detailed documentation of your disability strengthens your case significantly.
Common Reasons Chronic Pain Claims Get Denied
Insurance companies use several tactics to deny chronic pain claims. Understanding these reasons helps you avoid them:
- Insufficient medical documentation – Your medical records do not clearly describe how pain limits work ability. Weak medical evidence is a common reason for denials.
- Gaps in treatment – You have not seen a doctor recently, giving insurers reason to doubt your condition. Consistent medical treatment is essential for approval.
- Inconsistent statements – Your medical records say one thing, but your claim forms say another. Consistency across all documentation is critical.
- Vague language – You describe yourself as “disabled” without explaining specific functional limitations. Specific functional limitations matter more than diagnoses.
- Social media evidence – Photos or posts contradict your disability claim. Social media and disability claims require careful management.
- Failure to attend independent medical exams – Refusing an IME can result in claim denial. Learn more about when insurance companies use IMEs against you.
Why Choose Capitan Law
Capitan Law represents clients with chronic pain conditions across the country. Our attorneys understand the challenges of proving chronic pain disability claims, particularly the credibility issues and surveillance tactics insurance companies use. We have successfully appealed denied claims for fibromyalgia, CRPS, and post-surgical pain by building comprehensive evidence of functional limitations. We work on a contingency basis, meaning you pay nothing unless we recover your benefits.
Learn more about our firm and our track record of successful disability claim outcomes. Our experienced disability attorneys have recovered millions for clients with chronic pain conditions.
Frequently Asked Questions
Can fibromyalgia qualify for long-term disability benefits?
Yes. Fibromyalgia can qualify if you document how widespread pain, fatigue, and cognitive dysfunction prevent you from working. Focus on functional limitations: inability to sit or stand for required periods, concentration difficulties, and medication side effects that impact work performance. How chronic fatigue syndrome impacts disability claims shares similar documentation requirements.
What is CRPS and does it qualify for disability?
Complex Regional Pain Syndrome (CRPS) is severe pain in a limb after injury or surgery. It can qualify for disability if you show how pain and swelling limit your ability to perform job duties. Document specific functional losses such as inability to grip, lift, or walk. CRPS disability claims require specialized legal representation.
How long does it take to receive long-term disability benefits for chronic pain?
After filing, you typically wait through an elimination period (often 30 to 180 days, with 90 days being common) before benefits begin. The claims process itself can take weeks to months. Appeals can take 6 to 12 months or longer. Understanding the timeline helps you plan accordingly.
What happens if my chronic pain claim is denied?
You have the right to appeal. Many denials can be addressed with better documentation, additional medical evidence, and strategic presentation of functional limitations. Appealing a denied disability claim requires careful attention to deadlines and procedures. An attorney can help you evaluate your options.
Can insurance companies use surveillance against me?
Yes. Insurance companies may conduct surveillance to look for inconsistencies. Avoid posting on social media about your activities, and stay consistent in describing your limitations to doctors and the insurance company. Understanding surveillance tactics helps you protect your claim.
Take Action on Your Chronic Pain Disability Claim
If chronic pain prevents you from working, you may qualify for long-term disability benefits. Capitan Law offers free consultations to review your case and explain your options. Call (267) 419-7888 today to speak with a disability attorney about chronic pain disability claims. Our firm can get you the benefits you deserve.
